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Humber Cardio FINAL > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

What is heart valve disease? (2 big categories)

A

Stenosis (doesnt open properly )

Regurgitation (Doesnt close properly)

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2
Q

Mitral Regurg #1 etiology?
-Distinct signs and sxs?
-Heart murmur?

Aortic Stenosis #1 etiology?
-Distinct signs and sx’s?
-Heart murmur?

A
  1. Ischemia and infarcts
    -Prior MI or CAD, LVH, HF
    -Systolic
  2. Normal aging
    -Angina, syncope, carotid thrill, paradoxical S2 split
    -Systolic
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3
Q

Aortic Stenosis (AS)
1. Common in ?
2. If untreated, can lead to ?
3.Common sx’s?

  1. what’s the key to preventing HF?
    -For mild or no sx’s ___
    -Start __
A
  1. People over age 65
  2. HF and death
  3. fatigue, lightheadedness, syncope, swollen ankles or feet, SOB, chest pain, rapid fluttering heart beat
  4. Early treatment
    - maintain healthy lifestyle
    -medications
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4
Q

Aortic Stenosis : Medical Therapy prior to surgery

What drugs to use? (2)

A
  1. RAAS blocking therapies (ACEI’s and ARBS)
  2. statins in all pt’s with calcific AS (Indicated for primary and secondary prevention of atheroschlerosis)
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5
Q

Aortic Regurg (AR)
1. Causes of AR?
2. Blood leaks back into LV which leads to ?

  1. Common sx’s?
    -Mild
    -Severe
A
  1. endocarditis or abnormalities of the aorta (i.e dissection)
  2. Ventricular hypertrophy, HF
  3. Very few sx’s
    - heart palpitations, chest pain, fatigue, SOB, difficulty breathing when lying down, weakness, fainting, or swollen ankles and feet
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6
Q

Aortic Regurg -Medical therapy prior to surgery

  1. Acute AR
    -____ reduction to stabilize patient
    -E
  2. Chronic AR
    -Non pharm such as ?
  3. For asymptomatic pt’s with chronic AR (Stages B and C) TX of ___ of SBP of ___ is recommended !!
  4. In pt’s with severe AR who have sx’s and or LV systolic dysfunction (Stage C2 and D) but a prohibitive surgical risk, what is recc?
A
  1. LV afterload to stabilize pt.
    -emergency surgery !
  2. Weight loss, healthy diet, regular exercise, smoking cessation, stress reduction
  3. HTN, >140
  4. GDMT for reduced LVEF with ACEI’s , ARBS, and or Entresto
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7
Q

Mitral Valve Stenosis (MS)
1. Incidence low in ?
2. Primary causes ? (4)
3. COmplications (6)
4. Signs and sx’s? (5)

A
  1. high income countries
  2. rheumatic fever (Untx Group A Beta hemo strep s.pyog), non-rheumatic calcified mitral valve (elderly ) , infective endocarditis, congenital stenosis (rare)
  3. Pulm congestion, pulm hypertension, right sided heart failure, AFIB , Thrombus formation , dysphagia
  4. HF sx’s, dyspnea, fatigue, hoarseness, hemoptysis
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8
Q

Mitral Stenosis Med Therapy

What kind of therapies? (2)

A

See Chart

-Warfarin for anticoag
-Rate control

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9
Q

Mitral Regurg -Acute
1. Treatment using vasodilator therapy such as ? (2)
-CAn also use IABP? (define)
-Mitral Valve __ or __

A
  1. Nicardipine, nitroprusside
    - Intra-aortic balloon pump
    -repair, replacement
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10
Q

Mitral Regurg -Chronic

  1. Chronic primary MR
    -____ MR
    -Disease of valve apparatus such as ___
  2. Chronic secondary MR
    -___ MR
    -Disease of ventricle or atria such as ____

recommendations see chart **

  1. Whats the drug treatment for Secondary MR? **
A
  1. Degenerative
    - mitral valve prolapse
  2. Functional
    - LV dysfunction caused by CAD
  3. Treat like HF : ACEI’s/ARBS/ARNI + B blockers, MRA , + biventricular pacing
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11
Q

Valve Replacement Surgery : Prosthetic Heart valves

  1. Mechanical
    -Material ?
    -Valve life span?
    -Low rates for ?
    -Higher risk for ?
    -Audible ___
    -Lifelong anticoag with __
  2. Bioprosthetic / Tissue
    -Material ?
    -Valve life span?
    -High rates of ?
    -Lower risk for ?
    -No audible ?
    -NO LONG TERM ___
A
  1. metal
    > 20 yrs
    -reoperation
    -valve thrombosis
    -clicking sound
    -warfarin **
  2. Porcine valve
    - 10-15 yrs
    - valve degen leading to higher risk for valve replacement or repair
    - valve thrombosis
    -clicking sound
    -anticoag needed
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12
Q

Installing New Valves

  1. Surgical for which kind of valves?
  2. Transcatheter for what kind of valves and which specific heart valves?
A
  1. mechanical or bioprosthetic
  2. Bioprosthetic only
    -Aortic > Mitral
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13
Q

Anticoag drugs used after valve replacement

  1. What to use for mechanical heart valves?

** See chart !***

A
  1. Warfarin
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14
Q

Anticoag For On-X AVR

  1. FDA approved w/less intense __ .leads to > 60% reduction in ___ and no increase in ___
  2. much lower risk of ___ than ___
  3. ANticoag
    -First 3 months what do u use?
    -After first 3 months , if no thromboembolic RF’s may reduce ____ and continue __
A
  1. Warfarin
    - bleeding
    -thromboembolism
  2. reoperation , bioprosthetic valves + less bleeding
  3. standard warfarin (goal INR 2-3) + ASA 81 mg
    - Warfarin intensity (goal INR 1.5-2.0) , ASA 81
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15
Q

Bridging Therapy :

  1. Bridging agents? (2)
    -Whats the UFH target for anti xa and aPTT ?
    -Whats the LMWH dose and whats the target ?
  2. bridging is typically done for ___ or ___
A
  1. IV UFH or LMWH
    -Anti Xa 0.3-0.7 IU/mL or aPTT 50-77 sec
    -Enoxaparin 1mg/kg SC q 12hrs targeting 0.5-1.0 IU/mL 4 hrs post dose
  2. mechanical MVR or AVR + Additional Thromboembolic risk factors
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16
Q

Pregnancy :
1) If valve replacement, which is preferred?
2) In preg women with VHD, which meds are reasonable as required for HR control or tx of arrhythmias?
3) In preg women with VHD and HF sx’s (Stage D), which meds reasonable if needed for volume overload?
4) In preg women with VHD, Which meds should not be given ?

A
  1. bioprosthetic valves
  2. Beta blockers
  3. Diuretics
  4. ACEI’s and ARBS
17
Q

Anticoag For Preg Women WITH Mechanical Heart valves

  1. What are the drawbacks to using warfarin ?
  2. What is good about using LMWH?
  3. What are 3 potential strategies?

–> See chart!!!

A
  1. Crosses placenta. Fetal toxicity.
  2. Not teratogenic, but doesnt work as well to prevent valve thrombosis
    -needs to be dosed appropriately and MUST BE monitored with Anti-Xa levels
  3. Continue warfarin throughout pregnancy
    -use heparin throughout pregnancy
    -Use sequential therapy w/heparin during 1st trimester and warfarin during 2nd and 3rd trimesters

Humber Cardio FINAL (13 decks)

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